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When is external cephalic version done What is the success rate of external cephalic version What is a transverse lie
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What are the two types of transverse lie
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What is the incidence of transverse lie
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1 in 300 deliveries Many more are transverse early in gestation, but convert spontaneously before term Cesarean delivery External cephalic version Placenta previa Prolapsed umbilical cord Fetal trauma Prematurity
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What are the options for the intrapartum management of transverse lie What potential problems can be associated with transverse lie
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Section III: Topics in Obstetrics
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ABNORMAL FETAL TESTING
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What causes non-reassuring fetal testing Fetal hypoxia or acidosis, which in turn can be caused by: Maternal diseases (eg, hypotension, hypoventilation) Placental problems (eg, insufficiency, abruption) Uterine factors (eg, hyperstimulation, uterine rupture) Fetal factors (eg, umbilical cord prolapse, arrhythmia, infection) What is the fetal response to transient hypoxia What are the fetal responses to prolonged hypoxia Initially, slowing of the fetal heart rate resulting in decelerations Persistent bradycardia Repetitive late decelerations Loss of heart rate variability Loss of fetal biophysical activities (low BPP) (see Fig 9-9) What is a reassuring fetal heart rate pattern Rate between 110 and 160 beats per minute (bpm) with accelerations No decelerations Variability between 6 and 25 bpm Fetal acidosis is suggested by what findings on a fetal heart tracing Decelerations: prolonged (>2 minutes and <10 minutes) decelerations, late decelerations, or periodic severe variable decelerations Minimal (<5 bpm) or absent longterm variability Tachycardia (>160 bpm for more than 10 minutes) or bradycardia (<110 bpm for more than 10 minutes) How is fetal acidosis directly assessed What is the most common cause of fetal tachycardia What are some other causes of fetal tachycardia Blood is sampled from fetal presenting part Maternal tachycardia Maternal fever Fetal anemia Asphyxia Infection Autoimmune disorders
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9: Complications of Pregnancy
Figure 9-9 Antepartum fetal heart rate tracings at 28 weeks gestation in woman with diabetic ketoacidosis A During maternal and fetal acidemia B Return of normal accelerations (Reproduced, with permission, from Cunnigham FG et al: Williams Obstetrics, 22nd ed New York: McGraw-Hill, 2005:378)
Adrenergic medications Fetal cardiac arrhythmia (eg, sinoventricular tachycardia [SVT]) What is fetal bradycardia What are some of the causes of fetal bradycardia A baseline FHR <110 bpm Physiologic (short episodes because of transient compression of the fetal head/umbilical cord) Maternal hypotension Local anesthesia (eg, paracervical block) Uteroplacental insufficiency (eg, placental abruption, uterine rupture, cord prolapse) Fetal cardiac arrhythmia
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Section III: Topics in Obstetrics
What are the different classifications of fetal heart rate variability
Absent Minimal (<5 bpm) Moderate (6 25 bpm) Marked (>25 bpm)
What is suggested by a sinusoidal pattern on electronic fetal monitoring (EFM) How can chronic fetal stress be manifested
Fetal anemia, hypoxia, or exposure to sedative hypnotics Oligohydramnios (AFI <5 cm or maximum vertical pocket <2 cm), decrease in BPP score, intrauterine growth restriction, or abnormal umbilical artery doppler assessment Brain, heart, adrenals, and placenta Systolic versus end diastolic flow velocity (S/D flow) in the umbilical vessels, middle cerebral artery, and ductus venosus It is gestational age-dependent At term, <3 Placental insufficiency Early, late, and variable A gradual decrease from baseline that mirrors a contraction with the nadir of the heart rate at the same time as the peak of the contraction A vagal response from compression of the fetal head during uterine ctx; they are normal A rapid decline of more than 15 beats from the baseline The shape and timing of the deceleration is variable They may or may not occur with contractions Usually cord compression (can be relieved by changing the mother s position) If mild or moderate: expectant management If severe and periodic: move mother to left or right lateral decubitus position; consider stopping oxytocin
During hypoxic stress, where is fetal blood preferentially shunted How is feto-placental perfusion assessed with doppler ultrasound
What is a normal umbilical artery S/D ratio What is a high umbilical artery S/D ratio associated with What are the three types of decelerations Describe early decelerations
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